1. Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method
- Author
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Ognjen Gajic, Samuel M. Galvagno, Elie Azoulay, Adam M. Deane, Jan Bakker, Massimo Antonelli, Sangeeta Mehta, Pauline K. Park, Yaseen M. Arabi, David Pilcher, Krishnaswamy Sundararajan, Gopi C. Khilnani, Paolo Pelosi, Suveer Singh, Laurent Brochard, Younsuck Koh, Bin Du, Massimiliano Sorbello, Waleed Alhazzani, Jason Phua, Lise Piquilloud, John Victor Peter, Prashant Nasa, Sachin Gupta, Armand Mekontso-Dessap, Manu L N G Malbrain, Sharon Einav, Michael T. McCurdy, Manu Shankar-Hari, Claude Guérin, Yash Javeri, Jean-Baptiste Lascarrou, Samir Jaber, Ashish Khanna, Jordi Mancebo, Pradeep Rangappa, Deven Juneja, Andrés Esteban, Sheila Nainan Myatra, Marcus J. Schultz, Ravindranath Tiruvoipati, Andrew A. Udy, Brendan McGrath, Flávia Ribeiro Machado, Michael Nurok, Tobias Welte, Mervyn Mer, Ravi Jain, Peter Schellongowski, NMC Specialty Hospital, Al Nahda, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Wake Forest School of Medicine [Winston-Salem], Wake Forest Baptist Medical Center, Mahatma Gandhi Hospital, Narayana Super Speciality Hospital, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, King Saud Bin Abdulaziz University for Health Sciences [Riyadh] (KSAU-HS), New York University School of Medicine (NYU), New York University School of Medicine, NYU System (NYU)-NYU System (NYU), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Pontificia Universidad Católica de Chile (UC), Keenan Research Centre of the Li Ka Shing Knowledge Institute [Toronto], The Royal Melbourne Hospital, Peking Union Medical College Hospital [Beijing] (PUMCH), Shaare Zedek Medical Center [Jerusalem, Israel], CIBER de Epidemiología y Salud Pública (CIBERESP), Mayo Clinic, University of Maryland School of Medicine, University of Maryland System, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), University of Ulsan, Centre hospitalier universitaire de Nantes (CHU Nantes), Federal University of Sao Paulo (Unifesp), International Fluid Academy, Vrije Universiteit Brussel [Bruxelles] (VUB), Hospital Universitari Sant Pau, Barcelona, Manchester University NHS Foundation Trust (MFT), Manchester Academic Health Sciences Centre [Manchester, UK], Mount Sinai Health System, Hôpital Henri Mondor, Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Henri Mondor, University of the Witwatersrand [Johannesburg] (WITS), Cedars-Sinai Medical Center, University of Michigan Medical School [Ann Arbor], University of Michigan [Ann Arbor], University of Michigan System-University of Michigan System, Ospedale Policlinico San Martino [Genoa], Università degli studi di Genova = University of Genoa (UniGe), Christian Medical College and Hospital Ludhiana [Punjab, India] (CMCHL), National and Kapodistrian University of Athens (NKUA), Monash University [Melbourne], Lausanne University Hospital, Medizinische Universität Wien = Medical University of Vienna, VU University Medical Center [Amsterdam], Mahidol University [Bangkok], University of Oxford [Oxford], Guy's and St Thomas' Hospital [London], King‘s College London, Royal Brompton Hospital, Chelsea and Westminster Hospital, Monash College [Melbourne], German Center for Lung Research - DZL [Munich, Germany], Tata Memorial Centre, Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, ACS - Pulmonary hypertension & thrombosis, Intensive Care Medicine, AII - Infectious diseases, ACS - Diabetes & metabolism, ACS - Microcirculation, and Epidemiology
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medicine.medical_specialty ,ARDS ,COVID-19 acute respiratory distress syndrome ,Consensus ,Delphi Technique ,medicine.medical_treatment ,education ,Delphi method ,Critical Care and Intensive Care Medicine ,[SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract ,Prone ventilation ,03 medical and health sciences ,0302 clinical medicine ,Respiratory Insufficiency/therapy ,COVID-19 high flow nasal oxygen ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,COVID-19 respiratory management ,medicine ,Humans ,COVID-19/complications ,Respiratory Insufficiency/virology ,COVID 19 invasive mechanical ventilation ,COVID-19 ventilatory management ,Respiratory distress syndrome adult ,Intensive care medicine ,Personal protective equipment ,Positive end-expiratory pressure ,11 Medical and Health Sciences ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,business.industry ,Research ,Tracheal intubation ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,COVID-19 ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,medicine.disease ,Emergency & Critical Care Medicine ,COVID-19 high fow nasal oxygen ,3. Good health ,030228 respiratory system ,Respiratory failure ,Breathing ,business ,Respiratory Insufficiency - Abstract
Background Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Methods Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p Results Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16–24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. Conclusion Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. Trial registration: The study was registered with Clinical trials.gov Identifier: NCT04534569.
- Published
- 2021
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